No excuses, no nannying (well, maybe just a bit….)


Shadow Health Secretary Andrew Lansley unveiled his public health agenda at an event with centre-right think-tank Reform this morning. Key amongst his proposals was introducing a separate budget for public health, more evidence-based practice and the appointment of local directors of public health.

He also acknowledged the role that individuals must take in their own health with the mantra ‘No Excuses, No Nannying’. Building on Cameron’s earlier comments around the “moral neutrality" of society, the Conservative approach to healthcare would be to ask us (or at least ‘nudge’ us) to take more responsibility for our lifestyle choices.

Putting aside the debate over whether how much we eat and how little we move has anything to do with the state, we are left with the question whether, in a taxpayer funded system, any amount of ‘nudging’ can galvanise patients into taking more responsibility for their health? Indeed, a system that makes no direct link between what a patient pays in and how much they get out is one that will, perhaps inevitably, promote irresponsible attitudes on the part of individuals.

One way to encourage more responsibility would be to roll out individual budgets on a wider scale, giving patients a sense of ownership over their health and well-being by allowing them to manage and control their healthcare spending. This, I am told, is something that Mr Lansley is very keen on.

But, with the cost-pressures mounting on the health service perhaps we need to start thinking about radically different approaches to the way that healthcare is delivered and funded? To this end, medical savings accounts could be a model well worth considering. By placing money spent on medical services directly in the hands of the consumer patients are encouraged to become more actively involved in their own health. And, both by making preventative expenses eligible for coverage and by allowing people to keep the money they don’t use, medical savings accounts contain an in-built mechanism that promotes public health without the need for government regulation and interference. ‘No Excuses, No Nannying’ required.